PATIENT INFORMATION

Patient Information

Patient Portal 

You may access your medical records in our electronic personal health record (PHR) by following the link below:


PATIENT FUSION:

YOUR PERSONAL HEALTH RECORD: Click Here

You will need the access code which was sent to the email address listed when you established care. If you have not received an email with this information, please contact us, and we will activate your patient portal.

Appointment Checklist 

Please read the following checklist carefully to ensure that you have everything necessary for your visit to Elysium.


First Appointment

Please arrive at least 30 minutes before your first appointment.


The following should be brought with you to your first appointment


Current insurance card(s)

Applicable insurance copay, deductible, or payment in full if you are not covered by insurance. Payment depends on your insurance type and plan. Payments are collected when you check-in.


Valid photo ID

For your protection, federal regulations require that patients provide photo identification at appointments.


Medicines that you are currently taking

Please bring the medicines in their actual bottles so your medical care provider can know exactly what medications and dosages you are on.


Medical Records

It is very important that we have your past medical records. Please verify that these records are being mailed or faxed to us from your previous physician's office prior to your appointment. If you have not already done so, please complete the Medical Records Release form and turn it into our Medical Records Department as soon as possible.


Subsequent Appointments

Please arrive at least 15 minutes prior to your appointment.


The following should be brought with you to every appointment:

  • Current insurance card(s)
  • Valid photo ID
  • Applicable insurance copay, deductible, or payment in full if you are not covered by insurance. Payment depends on your insurance type and plan. Payments are collected when you check-in.


Care Credit

CareCredit

Elysium MedSpa has partnered with Care Credit to offer you convenient payment plans for your cosmetic procedures. With their simple online application processes and instant decisions, anyone can schedule his or her procedure that day and pay for it over time with little to no interest.


With CareCredit, you can pay for treatments and procedures for you and your family right away and then make convenient monthly payments.


CareCredit extends special financing offers that you can’t get when using your Visa or MasterCard to pay for health, beauty and wellness care at enrolled providers. With shorter term financing options of 6, 12, 18 or 24 months no interest is charged on purchases of $200 or more when you make the minimum monthly payments and pay the full amount due by the end of the promotional period. If you do not, interest is charged from the original purchase date


CareCredit also extends longer-term healthcare financing for 24, 36, 48 or 60-month periods with a Reduced APR and Fixed Monthly Payments Required until paid in Full.

CLICK HERE TO APPLY FOR CARE CREDIT CLICK HERE TO PAY YOUR CARE CREDIT BILL

Insurance Guide 

After your appointment, we will submit a bill (also called a claim) to your insurance company, if you have insurance. This bill will list the services we provided to you. Your insurance will use the information in the bill to pay us for those services.


When the insurance company pays us, they may send you a report called an Explanation of Benefits, or EOB. The EOB shows what your insurance company did and did not pay for and why. An EOB is not a bill


Your Statement from Us

If you have insurance, you may receive a statement that shows how much we billed your insurance company. You do not need to pay the amounts listed at that time

You will need to pay any balance due after your insurance company pays us.


We Accept Most Major Insurance Providers:

  • Aetna
  • Blue Cross/Blue Shield (Except My Blue Plan)
  • Cigna
  • Humana HMO
  • Medicare
  • United Health Care

Just because your health insurance provider isn’t listed doesn’t mean we don’t accept it. To be sure of your coverage and benefits please call your member services line (provided by your insurance provider) and provide them with our NPI Number: 1457338519


Why did my insurance pay only a part of my bill?

Most insurance plans require that you pay a co-payment, coinsurance or deductible for your health care expenses. Contact your health insurance company for specific information about your coverage.


What is a deductible?

Deductibles are the yearly expenses you pay before your health insurance pays anything. For example, each year you pay the first $1,000 of your health care bills before your health insurance pays anything.


What is coinsurance?

Coinsurance is a percentage of the health care bill that you pay after you have reached your annual deductible. For example, you pay 20% and your insurance company pays 80%.


What is a co-payment?

Copayments are set amounts you pay when you go to a health care provider. Providers usually collect copayments at the visit. Copayment amounts usually are listed on your health insurance card.


Why did I receive a bill if I have insurance coverage?

You will receive a patient responsibility statement after your insurance processes our bill. The amount you are billed for is based on what your insurance communicates to us on an explanation of benefits (EOB). The EOB details how your insurance processed our bill and calculated your responsibility based on your individual insurance plan. If you believe your responsibility is not correct, please contact your insurance directly.


My insurance should have paid my bill, what should I do?

Please verify that your insurance has received and processed the claim. If the claim has not been processed, then carefully review your insurance policy or contact your insurance to determine if the services and procedures are covered. Your insurance will have the most accurate and up-to-date information about your policy and your claim. If your insurance company has questions, please direct them to contact Elysium Medical Group at one of our locations to verify that the most up to date insurance information is on file.


Why am I getting a bill now, when services were provided so long ago?

Elysium Medical Group will process and send a bill to a patient after payment and EOB are received from the insurance and it is confirmed that the balance is owed by the patient. The length of this process depends on how long it takes to receive a response from your insurance carrier.


Why is my account in collection?

Delinquent in payment will result in collection activity. Once we have received EOB from your insurance, we will send out billing statement for your account balance. Failure to send in payment within 90 days from the first statement sent, your account will be turned into our contracted collection agency. When the account is in the collection agency, it is no longer with Elysium Medical Group. You will not be able to visit our providers once your account is in collection. You will have to contact the collection agency directly to resolve bad debt in order to visit our providers again.


Why did I receive a bill for a preventive exam?

Each insurance company has a list of preventive services they will cover for your preventive exam. If any non-preventive services or medical conditions were addressed during your exam that required more evaluation, you may be billed for that service. Insurance requires accurate, detailed reporting from providers when preventive care and additional problems are addressed in the same visit. Please contact your insurance to find out the covered preventive services for your preventive exam

HIPAA Notice

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we've shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Include you in a hospital directory
  • Provide mental health care

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director
  • Address workers' compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.


Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.


Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say "no" to your request, but we'll tell you why in writing within 60 days.


Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say "yes" to all reasonable requests.


Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.


Get a list of those with whom we've shared information

  • You can ask for a list (Accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 


Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.


Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.


File a complaint if you fell your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on our website.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.


In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory


If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.


In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes


In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically share your health information?

We typically use or share your health information in the following ways:


Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.


Run our organization

We can use and share your information about you to run our practice, improve your care and contact you when necessary.

Example: We use health information about you to manage your treatment and services.


Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.


How else can we use or share your health information?

We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.


Help with public health and safety issues


We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone's health or safety

Do research

We may use and disclose your Protected Health Information for research purposes to the extent allowed by law. This will only be done if the research has been specially approved by your health care provider and an authorized institutional review board or a privacy board that has reviewed the research proposal and has established protocols to ensure the privacy of your Protected Health Information. We may permit researchers to look at Protected Health Information to help them prepare for research, for example, to develop a protocol or identify potential participants in the research project. No Protected Health Information will be removed or copied. If your provider thinks a research study may benefit you, you may be contacted by our research team. Participation in the research study is purely voluntary and will in no way impact your continued medical care with the Practice.



Comply with the law

We will share information about you in state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.


Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.


Work with a medical examiner or funeral director

we can share health information with a coroner, medical examiner, or funeral home director when an individual dies.


Address workers' compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers' compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services


Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

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