Notice of Privacy Practices

Introduction and Purpose

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.

Masters Spine Institute (official business name is Masters Spine Center LLC) provides spine, orthopedic, and pain management care. We offer care on a self-pay basis and through bundled-price arrangements.

This Notice applies to all records of your care created or received by our practice, including records kept by our physicians, advanced practice providers, staff, and anyone we authorize to enter information into your record.

If you have questions about this Notice, contact our Chief Operating Officer: Kyle Bennion, Masters Spine Institute, 913 W Baxter St, Suite #102, South Jordan, UT, (833) 674-3627

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your protected health information (“health information”).
• Give you this Notice of our legal duties and privacy practices.
• Follow the terms of the Notice currently in effect.
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your unsecured health information.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you may change your mind at any time by letting us know in writing, except to the extent we have already acted on it.
• Where state law gives your health information more protection than federal law, we will follow the stricter law.

How We May Use and Share Your Health Information

Treatment. We use and share your information to provide and coordinate your care. For example, we may share imaging, exam findings, and medication history with a referring physician, radiology or imaging center, surgical facility, anesthesia provider, physical therapist, laboratory, or pharmacy involved in your care.

Payment. We use and share your information to bill and collect for services. Because we are a cash-pay and bundled-price practice, this may include:

• Providing you with good faith estimates, invoices, and itemized receipts.
• Sharing information with facilities, surgeons, anesthesia providers, or other partners who are paid through a bundled-price arrangement for your episode of care.
• Sharing information with an employer health plan, direct-contracting program, benefits navigator, or other third-party payer only if you have chosen to have that party pay for or arrange your care.
• Providing records you request so you can seek reimbursement from your own insurer.

Health care operations. We use and share your information to run our practice and improve care, such as quality review, staff training, outcome tracking, licensing and accreditation, legal and compliance services, and business planning.

Business associates. We may share information with vendors who perform services for us, such as electronic health record, billing, payment processing, scheduling, transcription, IT, and legal services. Each must sign a written agreement to protect your information.

Communications with you. We may contact you with appointment reminders, test results, post-procedure follow-up, billing notices, and information about treatment alternatives or health-related services we offer. We may use phone, text, email, mail, or a patient portal, using the contact information you give us.

Family members and others involved in your care. We may share information with a family member, friend, or other person you identify who is involved in your care or helps pay for it, such as a person driving you home after a procedure. You may tell us not to do this. If you are unable to agree or object, we will use our professional judgment about what is in your best interest.

Other uses and disclosures permitted or required by law. We may share your information without your authorization in these situations: As required by law; Public health and safety; Prescription drug monitoring, as required by state law; Health oversight; Lawsuits and legal actions; Law enforcement; Workers’ compensation; Coroners, medical examiners, and funeral directors; Organ and tissue donation; Research; Specialized government functions; and Correctional institutions, if you are an inmate or in lawful custody.

Uses That Require Your Written Authorization

We will ask for your written permission before we: Use or share psychotherapy notes, if any exist; use or share your information for marketing purposes; sell your health information; use or share your information for any purpose not described in this Notice. We do not sell patient information, and we do not use it for marketing without your written authorization.

Substance Use Disorder Treatment Records

Some records we receive from federally assisted substance use disorder treatment programs are protected by a separate federal law, 42 CFR Part 2. We will not use or share those records, or testimony about their contents, in any civil, criminal, administrative, or legislative proceeding against you unless you give specific written consent or a court issues an order after notice and an opportunity to be heard, as that law requires. Where Part 2 records are shared with us under your consent for treatment, payment, and operations, we may use and redisclose them as HIPAA permits, subject to these limits. You have the right to elect not to receive fundraising communications that use those records.

Your Rights

To use any of these rights, contact our Privacy Officer using the information at the top of this Notice.

• Get a copy of your records. You may see or get a copy of your medical and billing records, on paper or electronically. We will respond within 30 days, as required by law. We may charge a reasonable, cost-based fee.
• Ask us to correct your records. You may ask us to correct information you believe is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications. You may ask us to contact you in a specific way, such as a certain phone number or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. You may ask us not to use or share certain information for treatment, payment, or operations. We are not required to agree, and we may say no if it would affect your care.
• Restrict disclosures to a health plan when you pay in full. If you pay for a service or item out of pocket in full, you may ask us not to share information about it with your health plan for payment or operations. We will say yes unless a law requires us to share it. As a cash-pay practice, we do not bill health plans on your behalf unless you direct us to.
• Get a list of those we’ve shared information with. You may ask for a list of the times we shared your information in the six years before your request, who we shared it with, and why. This list excludes disclosures for treatment, payment, and operations and certain others, such as those you authorized. We provide one list a year free; we may charge a reasonable, cost-based fee for more.
• Get a copy of this Notice. You may ask for a paper copy at any time, even if you agreed to receive it electronically. This Notice is also posted in our office.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person may exercise your rights. We will confirm the person has this authority before we act.

Changes to This Notice

We may change this Notice, and the changes will apply to all information we have about you. The new Notice will be available on request, in our office, and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer at the address above. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by writing 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.

A paper copy of this Notice is available in our office or on request.