Sara's Cancellation Policy:
Patients who cancel with fewer than 24 business hours notice will be charged $100. For example, you must call by Friday at 3:00 pm to cancel a Monday 3:00 pm appointment.
This $100 cancellation fee applies to the following real-life examples taken from my practice in recent years:
“I am having a toxic emergency.”
“I poured laundry detergent in my eye.”
“I am stuck in Cuba because there is no co-pilot for the plane.”
I am not kidding.
The one exception to the 24 business hours rule is snow. In the case of snow, I will follow the lead of the local schools and government offices. For example, a two hour delay will exempt the 8:00am and 9:00am patients and school closures will exempt all patients from the cancellation policy for that day. Please note, I have never missed work because of snow and plan to be in the office if you want to keep your appointment on a snow day.
Payment is due at the time of service. Cash, checks and credit/debit cards are accepted. A 2.75% convenience fee will be added to all card transactions.
Medicare Benefit Policy:
Physical therapists cannot opt out of the Medicare program at this time. As a result, I cannot provide covered physical therapy services to Medicare patients. However, there are two exceptions to this rule:
1. I can provide services to Medicare patients that are otherwise not covered such as wellness,
prevention, and fitness.
2. If a Medicare patient “refuses, of his/her own free will, to authorize the submission of a bill to
Medicare” (section 40, chapter 15 of the Medicare Benefit Policy Manual), I can accept self
payment for physical therapy services.
If you meet one of the two conditions above and want to come see me, I will be asking you to sign an agreement that states neither you nor I will send claims to any 3rd party payor (Medicare and all secondary insurances) and you will not allow anyone else to send claims on your behalf.
Trigger Point Dry Needling Description:
Trigger point dry needling (TPDN) involves placing a small needle into a muscle at the site of the trigger point. This causes the muscle to contract and then release, improving flexibility and thereby decreasing symptoms. Dry needling is not acupuncture and is only one part of physical therapy. It is a valuable and often effective treatment for musculoskeletal pain. Like any treatment there are possible complications. While these complications are rare in occurrence, they are real and must be considered prior to giving consent to treatment.
The most serious risk associated with TPDN is accidental puncture of a lung (pneumothorax). If this were to occur, it may likely require a chest Xray and no further treatment. Symptoms of shortness of breath may last for several days to weeks. A more severe lung puncture can require hospitalization and reinflation of the lung. This is a rare complication. Other risks may include excessive bleeding, infection, nerve injury and on rare occasions fainting. Bruising is a somewhat common occurrence and should not be a concern. Please let me know if you are taking blood thinners. As the needles used in TPDN are small and do not have a cutting edge, the likelihood of any significant tissue trauma is unlikely buy possible.
Your Privacy Rights:
Sara's HIPAA Notice of Privacy Practices
As your physical therapist, I believe your right to privacy is a fundamental part of your treatment; as such, I want you to understand my privacy practices and procedures. Should you have any questions regarding these policies please ask.
Information I collect about you: I collect personal information about you as part of the registration process, during the course of your care, and from other health care entities you utilize such as hospitals, physicians/specialists, and imaging facilities. This personal information includes items such as your name, address, phone number, email address, date of birth, employer, health history, and any other information you provide.
How your information is used: The personal and health information gathered may be used and disclosed with your general consent for the following purposes: treatment, securing payment, health care operations, appointment reminders, as required by law, to avert a serious threat to health or safety, to military command authorities, to law enforcement, for public health risks, for workmen’s compensation, as ordered by a court, to coroners, and to national security agencies.
Your rights regarding your privacy: You have the right to inspect, copy (copying fees apply), and amend your health information. You have the right to request a reasonable restriction or limitation on the health information I use or disclose about you for treatment, payment, or health care operations. You have the right to request confidential communication. All of the above requests must be made in writing and submitted to Fluid Manual Therapy, LLC. I will accommodate all reasonable requests. If you feel your privacy has been violated, you have the right to file a complaint with the Department of Health and Human Services. The complaint in no way influences your course of treatment with Fluid Manual Therapy.