*We reserve the right to change the services, prices, policies, and business hours at any time and without advance notice.
With the exception of Medicare, Dr. Piker is considered an “out-of-network provider” for the commercial and state-sponsored insurance plans.
The prices for our services are listed on the Booking Page.
- The prices listed do not apply to Medicare recipients; please see Medicare Policy for details.
We ask ALL clients (including Medicare recipients) to provide the credit or debit card information to reserve appointment. We use the Stripe online payment processing for all transactions.
- We do not charge your card at the time of booking.
- Your card will be automatically charged the full amount of the listed visit price at the time of your appointment.
- This does not apply to Medicare recipients; please see the Medicare Policy for details.
Your insurance carrier may provide partial reimbursement of services by out-of-network providers. Please keep in mind that the PPO plans are more likely to reimburse the services of an out-of-network provider than the HMO plans.
- Reimbursement rates vary, with an average being around 60%.
- If commercially insured clients wish to be reimbursed for visits with Dr. Piker, we will provide them the so-called “superbill” which clients can submit to their insurance carrier for reimbursement.
- The clients bear sole responsibility for knowing the specific rules of their insurance carrier.
- It is highly recommended that clients consult their insurance company regarding the coverage of out-of-network providers prior to scheduling appointment.
The appointments can be rescheduled or cancelled online up to 24 hrs in advance.
- Please see the Rescheduling, Cancellation, and No-Show policies for details.
Dr. Piker is participating provider with the Medicare, and he accepts rates assigned by Medicare. The actual amount to be submitted to Medicare will be determined on the day of the visit.
The Medicare recipients will be billed whichever amount remains after reimbursement by Medicare and supplemental insurance (if applicable).
The Medicare recipients will be required to sign the Advance Beneficiary Notice of Noncoverage (ABN) form prior to procedures informing them of the estimated costs in case Medicare does not cover a particular procedure.
To avoid late cancellations and not showing up for the scheduled appointments, we ask ALL clients (including Medicare recipients) to provide the credit or debit card information at the time of booking your appointment.
- We do not charge your card at the time of booking.
- Please see the Rescheduling, Cancellation, And No-Show Policies for details.
Rescheduling, Cancellation, and No-Show Policies
We do not double-book or stack appointments as our clients deserve undivided attention and adequate time during the visit. When someone cancels with little or no notice or simply does not show up for their appointment, that time is wasted and there is no one to fill the empty slot.
At the same time, we understand that life happens and, depending on the circumstances, it may be necessary to cancel or reschedule an appointment on a short notice.
Therefore, we implemented the following rescheduling, cancellation, and no-show policies:
Rescheduling, Cancellations policy
- You can reschedule or cancel your own appointments without a penalty by visiting returning client page up to 24 hrs before the scheduled visit.
- If you need to reschedule or cancel your appointment with less than 24 hrs remaining, it is best to contact our clinic by calling 425-655-0700, messaging us via secure portal, or emailing us at firstname.lastname@example.org.
- The ‘LATE RESCHEDULE / LATE CANCELLATION’ fee is 50% of the listed service price, charged to the card provided at the time of appointment booking; this fee does not apply to nerve blocks or trigger point injections.
- You are considered a ‘no-show’ if you do not show up for your appointment without prior notification.
- You may be considered a ‘no-show’ if you arrive more than 15 min late for the 30 min appointment or more than 30 min late for the 90 min appointment without prior notification.
- The ‘NO-SHOW’ fee is 75% of the listed service price, charged to the card provided at the time of appointment booking.
The clients are financially liable for fees incurred for late cancellations, late arrivals, or missed appointments as these are not covered by either private or government insurances.
Thank you in advance for your understanding!
Communications and Emergencies
There are three ways to reach our clinic: calling our main telephone number 425-655-0700, emailing us at email@example.com, or messaging us via the secure Patient Portal. When leaving a voicemail, make sure to leave the client’s first and last names, date of birth, and the telephone number where the client can be best reached. The messages are typically responded to within one business day, although we try our best to screen the incoming messages during the business hours. Should Dr. Piker ever go on a vacation, the response time may be longer, and you may need to ask your primary care provider or other specialists for the temporary solutions (ie, prescriptions, acute treatments, etc).
Please be aware that the personal email is not a confidential means of communication. It is highly recommended to use our secure Patient Portal for messages containing personal medical information. Please make sure that your email filters are adjusted to deliver emails from the Integrative Headache Clinic domain (@ihclinic.org) and the secure portal domain (@intakeq.com) into your Inbox folder instead of Junk or Spam folders.
The Integrative Headache Clinic does not provide medical advice or treatments outside the posted business hours. Please do not use email or Patient Portal for urgent or emergent messages, as we cannot guarantee that the messages will always be received or responded to in a timely fashion.
If you’re experiencing the acute onset of new or rapidly worsening pre-existing neurological symptoms, concerning for a stroke or other acute neurological condition, or any other medical emergency, please contact 911 or go to the nearest Emergency Department right away. Please do not call, email, or send portal portal messages to the Integrative Headache Clinic if you’re experiencing either real or suspected emergency.
HIPAA Notice Of Privacy Practices
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.
About This Notice
This notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control 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.
We are required by law to maintain the privacy of your protected health information; give you this notice of our legal duties and privacy practices with respect to your protected health information; and follow the terms of our notice that are currently in effect. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at the time as well as any information we receive in the future. You can obtain any revised Notice of Privacy Practices by contacting our office.
How We May Use and Disclose Your Protected Health Information
The following examples describe different ways that we may use and disclose your protected health information. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. We are permitted to use and disclose your protected health information for the following purposes. However, our office may never have reason to make some of these disclosures.
We will use and disclose your protected health information to provide, coordinate, or manage your health care treatment and any related services. We may also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information 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.
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approvals and prior authorizations for diagnostic tests and other necessary treatments may require that your relevant protected health information be disclosed to your health plan to obtain approval for hospital admission.
We may disclose your protected health information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use third party vendors to schedule your appointments, perform billing services on our behalf, or conduct eligibility verifications for proposed treatments. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
For Health Care Operations
We may use and disclose your protected health information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use your protected health information to review the treatment and services you receive to check on the performance of our staff in caring for you. We also may disclose information to doctors, nurses, technicians, medical students, and other personnel for educational and learning purposes. The entities and individuals covered by this notice also may share information with each other for purposes of our joint health care operations.
Appointment Reminders, Treatment Alternatives, Health-Related Benefits and Services
Unless you object, we may use and disclose your protected health information to contact you to remind you that you have an appointment for treatment or medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
If your coverage is through an employer sponsored group health plan, we may share protected health information with your plan sponsor.
Required by Law
We may use or disclose your protected health information to the extent that the use or disclosure is 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. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose your 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.
Abuse or Neglect
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required by law.
We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose your protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the practice’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, Organ Donation
We may disclose your 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. We may also disclose your protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. 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 car · of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
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.
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity, National Security
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.
For Data Breach Notification Purposes
We may use or disclose your protected health information to provide legally required notices of unauthorized acquisition, access, or disclosure of your health information. We may send notice directly to you or provide notice to the sponsor of your plan, if applicable, through which you receive coverage.
Required Uses and Disclosures
Under the law, we must make disclosures to you and when required by the Secretary of the U.S. Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information
Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. For example, a health plan is not permitted to use or disclose genetic information for underwriting purposes. Some parts of this Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, you may contact our office for more information about these protections.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Uses and disclosures of your protected health information that involve the release of psychotherapy notes (if any), or other uses or disclosures not described in this notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization. Additionally, if a use or disclosure of protected health information described above in this notice is prohibited or materially limited by other laws that apply to use, it is our intent to meet the requirements of the more stringent law.
Your Rights Regarding Health Information About You
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information
This means you may inspect and obtain a copy of your protected health information that is contained in your designated file for as long as we maintain the protected health information. A “designated file” contains medical and billing records and any other records that your physician and the office uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. You must make a written request to inspect and copy your designated file. We may charge a reasonable fee for any copies. Additionally, if we maintain an electronic health record of your designated file, you have the right to request that we send a copy of your protected health information in an electronic format to you or to a third party that you identify. We may charge a reasonable fee for sending the electronic copy of your protected health information. Depending on the circumstances, we may deny your request to inspect and/or copy your protected health information. A decision to deny access may be reviewable. Please contact our office if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information
This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. This office is not required to agree to a restriction unless you are asking us to restrict the use and disclosure of your protected health information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you paid us out-of-pocket in full. If this office believes it is in your best interest to permit the use and disclosure of your protected health information, your protected health information will not be restricted. If this office does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by contacting our office.
You have the right to restrict information given to your third party payer if you fully pay for the services out of your pocket
If you pay in full for services out of your own pocket, you can request that the information regarding the services not be disclosed to your third party payer since no claim is being made against the third party payer.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location
We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our office.
You may have the right to have your physician amend your protected health information
This means you may request an amendment of protected health information about you in your designated file for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our office if you have questions about amending your medical record. Your request must be in writing and provide the reasons for the requested amendment.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information
This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. Additionally, limitations are different for electronic health records.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You have the right to receive notice of a security breach
We are required to notify you if your protected health information has been breached. The notification will occur by first class mail within 60 days of the event. A breach occurs when there has been an unauthorized use or disclosure under HIPAA that compromises the privacy or security of your protected health information. The notice will contain the following information: (1) a brief description of what happened, including the date of the breach and the date of the discovery of the breach; (2) the steps you should take to protect yourself from potential harm resulting from the breach; and (3) a brief description of what we are doing to investigate the breach, mitigate losses, and to protect against further breaches.
Complaints or Questions
You may file the complaint with us with the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a written complaint with us by notifying our office of your complaint. We will not retaliate against you for filing a complaint. For any questions, you may reach our office by calling 425-655-0700 or emailing at firstname.lastname@example.org.
Policies Updates and Changes
The Integrative Headache Clinic reserves the right to change any clinic policy at any time and without prior notice.
4140 Factoria Blvd SE Ste A, Bellevue, WA 98006